Prevalence of Depression and Anxiety and Their Association with Asthma Exacerbations in Adults

Abstract

Abstract Background: Asthma is a chronic respiratory condition that often coexists with mental health disorders such as anxiety and depression. These comorbidities may worsen asthma control and increase the risk of severe exacerbations, but their prevalence and impact across asthma populations remain underexplored. Objective: This systematic review aimed to summarise the prevalence of depression and/or anxiety among adults with asthma, compare it to estimates in the general adult population, and assess their association with asthma exacerbations. Where possible, secondary outcomes such as hospitalisation, asthma control, and quality of life were also examined. Methods: A systematic search was conducted across PubMed, Embase, PsycINFO, and the Cochrane Library for cohort studies published from 2015 onward in Europe and the UK. Eligible studies included adults with asthma and reported either the prevalence of depression and/or anxiety or their association with asthma outcomes or both. Data were extracted and synthesised according to PRISMA guidelines. Meta-analyses were conducted when appropriate. Results: Eleven cohort studies were included in the review, all of which investigated the prevalence and/or the relationship between mental health and asthma outcomes in adults. The reported prevalence of depression and/or anxiety among people with asthma ranged from 3.8% to 44%, indicating a substantial burden across European populations. Only five studies were eligible for meta-analysis; the remaining were excluded due to missing adjusted effect estimates or insufficient confounder control. Because the included studies reported different effect measures (odds ratios, hazard ratios, and incidence rate ratios), no overall pooled estimate was calculated. Instead, subgroup analyses were conducted by effect measure to reduce bias and maintain clarity. The pooled odds ratio from three studies showed asignificant association between depression and/or anxiety and asthma exacerbations (OR = 1.13; 95% CI: 1.08-1.18). Additional pooled estimates showed increased risk using hazard ratio (HR = 1.55; 95% CI: 1.05-2.29) and rate ratio (RR = 1.28; 95% CI: 1.22-1.34). Several studies also reported associations with poorer asthma control, increased hospitalisations, and reduced quality of life. Conclusion: Depression and anxiety are common in adults with asthma and are significantly associated with an increased risk of exacerbations and worse asthma outcomes. These findings support the need for routine mental health screening and integrated care approaches in asthma management. Further research is needed to explore whether treating mental health comorbidities can improve asthma prognosis.